Background: Health care organizations globally have seen a significant increase in the frequency of cyberattacks in recent years. Cyberattacks cause massive disruptions to health service delivery and directly impact patient safety through disruption and treatment delays. Given the increasing number of cyberattacks in low- and middle-income countries (LMICs), there is a need to explore the interventions put in place to plan for cyberattacks and develop cyber resilience. Objective: This study aimed to describe cybersecurity interventions, defined as any intervention to improve cybersecurity in a health care organization, including but not limited to organizational strategy(ies); policy(ies); protocol(s), incident plan(s), or assessment process(es); framework(s) or guidelines; and emergency planning, implemented in LMICs to date and to evaluate their impact on the likelihood and impact of attacks. The secondary objective was to describe the main barriers and facilitators for the implementation of such interventions, where reported. Methods: A systematic search of the literature published between January 2017 and July 2024 was performed on Ovid Medline, Embase, Global Health, and Scopus using a combination of controlled terms and free text. A search of the gray literature within the same time parameters was undertaken on the websites of relevant stakeholder organizations to identify possible additional studies that met the inclusion criteria. Findings from included papers were mapped against the dimensions of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework and presented as a narrative synthesis. Results: We included 20 studies in this review. The sample size of the majority of studies (13/20, 65%) was 1 facility to 5 facilities, and the studies were conducted in 14 countries. Studies were categorized into the thematic dimensions of the ECHO framework, including context; governance; organizational strategy; risk management; awareness, education, and training; and technical capabilities. Few studies (6/20, 30%) discussed cybersecurity intervention(s) as the primary focus of the paper; therefore, information on intervention(s) implemented had to be deduced. There was no attempt to report on the impact and outcomes in all papers except one. Facilitators and barriers identified were grouped and presented across national or regional, organizational, and individual staff levels. Conclusions: This scoping review’s findings highlight the limited body of research published on cybersecurity interventions implemented in health care organizations in LMICs and large heterogeneity across existing studies in interventions, research objectives, methods, and outcome measures used. Although complex and challenging, future research should specifically focus on the evaluation of cybersecurity interventions and their impact in order to build a robust evidence base to inform evidence-based policy and practice.

Self-assessment is a reflective practice enabling learners to evaluate their understanding (McMillan and Hearn, 2008). When fostering metacognitive processes, it can enhance learning by improving intrinsic motivation, understanding and learning strategies (Stanton, Sebesta and Dunlosky, 2021). The benefits for using self-assessment as a summative practice remains debated (for example, Andrade, 2019; Nieminen and Tuohilampi, 2020a; León, Panadero and García-Martínez, 2023). This paper presents the results of a summative self-assessment, on an undergraduate, larger (>100 students), technical module. The developed assessment on the module required submission of a critical self-assessment report around the technical work (i.e., portfolio) completed by students. Along with self-assessment, a combination of contract and negotiated marking was included into the assessment to encourage students’ early engagement with learning. It required completing weekly tutorials, a mid-term formative assessment, and submission of portfolio for an exhibition. The summative self-assessment comprised of a reflective, critical report around student engagement with learning as well as the quality of their completed portfolio. This paper outlines the thematic analysis of the interviews and survey results of the learners. It highlights the perceived benefits and concerns voiced around a summative self-assessment. Some of the results highlight the reduction in stress levels and greater depth of critical assessment of students’ own work. The paper offers practitioners an example on integrating summative self-assessment into teaching by [a] combining elements of contract assessment and negotiated marking, and [b] providing space for students to explore individual learning paths scaffolded through feedback.

Updating road network information requires determining an optimal path that visits all roads requiring data collection. This problem, known as the Rural Postman Problem (RPP), is traditionally addressed using relational databases. However, graph databases may offer advantages by more naturally representing network structures, where nodes represent junctions and edges represent roads. This study explores the novel representation of road networks using graph databases and its unique application in optimizing RPP algorithms. We implemented three existing algorithms—(a) Nearest Neighbor, (b) “Biased” Monte Carlo, and (c) Genetic algorithm—using Cypher and compared them with (d) a novel Cypher-only algorithm designed to compute the optimal path. The results show that the Nearest Neighbor algorithm was the fastest and produced the shortest paths among all algorithms. The Cypher-only algorithm could also identify optimal paths but failed to scale beyond five required edges. These findings highlight the limitations of using Cypher alone for solving the RPP but suggest that Neo4j and Cypher hold promise for further exploration.

BACKGROUND Health care organizations globally have seen a significant increase in the frequency of cyberattacks in recent years. Cyberattacks cause massive disruptions to health service delivery and directly impact patient safety through disruption and treatment delays. Given the increasing number of cyberattacks in low- and middle-income countries (LMICs), there is a need to explore the interventions put in place to plan for cyberattacks and develop cyber resilience. OBJECTIVE This study aimed to describe cybersecurity interventions, defined as any intervention to improve cybersecurity in a health care organization, including but not limited to organizational strategy(ies); policy(ies); protocol(s), incident plan(s), or assessment process(es); framework(s) or guidelines; and emergency planning, implemented in LMICs to date and to evaluate their impact on the likelihood and impact of attacks. The secondary objective was to describe the main barriers and facilitators for the implementation of such interventions, where reported. METHODS A systematic search of the literature published between January 2017 and July 2024 was performed on Ovid Medline, Embase, Global Health, and Scopus using a combination of controlled terms and free text. A search of the gray literature within the same time parameters was undertaken on the websites of relevant stakeholder organizations to identify possible additional studies that met the inclusion criteria. Findings from included papers were mapped against the dimensions of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework and presented as a narrative synthesis. RESULTS We included 20 studies in this review. The sample size of the majority of studies (13/20, 65%) was 1 facility to 5 facilities, and the studies were conducted in 14 countries. Studies were categorized into the thematic dimensions of the ECHO framework, including context; governance; organizational strategy; risk management; awareness, education, and training; and technical capabilities. Few studies (6/20, 30%) discussed cybersecurity intervention(s) as the primary focus of the paper; therefore, information on intervention(s) implemented had to be deduced. There was no attempt to report on the impact and outcomes in all papers except one. Facilitators and barriers identified were grouped and presented across national or regional, organizational, and individual staff levels. CONCLUSIONS This scoping review’s findings highlight the limited body of research published on cybersecurity interventions implemented in health care organizations in LMICs and large heterogeneity across existing studies in interventions, research objectives, methods, and outcome measures used. Although complex and challenging, future research should specifically focus on the evaluation of cybersecurity interventions and their impact in order to build a robust evidence base to inform evidence-based policy and practice.